Descending necrotizing mediastinitis: treatment of a delayed case

Descending necrotizing mediastinitis (DNM) is a severe and rare infection that can spread to the mediastinum through the anatomic cervical spaces, secondary to cervical or odontogenical infections. Delay of diagnosis and insufficient drainage always result in high mortality. We present a case of DNM with bilaterally pulmonary infiltration in a 45-year old woman. The cause of DNM was postextraction odontogenic abscess and delay of diagnosis which resulted in sepsis. Surgical treatment was performed as soon as possible in following sequence: cervical mediastinotomy, right thoracotomy, and pleural and mediastinal irrigation with saline. Although the diagnosis was delayed, invasive surgical interventions allowed successful eradication of the injection.